Complications Shorten Stroke Patients' Lives

Pneumonia, 2nd stroke can shave another 2 years off life span, researchers find

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THURSDAY, July 1, 2010 (HealthDay News) -- Complications from stroke, such as pneumonia or a secondary stroke, can shorten the lives of patients by an average of two years, researchers report.

"Previous studies have already shown that post-stroke complications increase mortality as well as disability," noted lead researcher Dr. Keun-Sik Hong, an associate professor in the department of neurology at Ilsan Paik Hospital, Goyang, South Korea. And the new study shows that "greater numbers of complications is associated with greater loss of healthy life years," he said.

For the study, Hong's team followed more than 1,200 stroke patients to see how they fared after their stroke. Patients were evaluated using the disability-adjusted life-year (DALY) metric, which was developed by the World Health Organization to measure the burden of disease mortality and disability.

Using DALY, Hong's team was able to calculate life span lost to stroke, as well as years lost due to stroke complications.

"Early post-stroke complications deprive patients of about two years of optimum health," on average, Hong said.

The researchers found that among stroke survivors overall, the average disability-adjusted life-years lost after the attack was just under four years. The average DALY for those without complications was just over three years, they note, but among patients suffering any complication the average DALY loss was more than five years.

And about 34 percent of patients suffered some type of complication within four weeks of their stroke. This included stroke progression, pneumonia, urinary tract infection, an additional stroke, seizures or heart attack, the researchers explained.

Hong's team calculated that patients with one complication lost an average of about 1.5 additional disability-adjusted life-years, while patients with two or more complications lost close to 2.7.

Analyzing the loss to patients in this way may "help decision-makers understand the burden of post-stroke complications and the imperatives of implementing organized stroke care more widely," Hong said.

Dr. Steven R. Levine, a professor of neurology at Mount Sinai School of Medicine in New York City, said that "we don't know how generalizable Korean patients are to America, so [the study] needs to be done again for American patients."

Korean patients seemed to have more intracranial complications than is seen in the United States, "so their numbers may be worse than ours, but it could be in the same ballpark," he said.

The best way to prevent loss of healthy years is to prevent stroke in the first place, Levine said. Stroke remains the leading cause of disability in the United States and the third leading cause of death, he noted.

Another expert, Dr. Larry B. Goldstein, director of the Duke Stroke Center at Duke University Medical Center in Durham, N.C., said that when complications occur after stroke, physical therapy and other interventions can help.

"Having complications is not a good thing," he said. "And anything we can do to reduce complications will, hopefully, be helpful."

Patient's conditions can also change over time, he said. "If somebody has an acute complication, it may affect how they are at three months, but not necessarily how they are at six months," Goldstein noted.